Mental Health Sciences Unit, University College London, London, United Kingdom.
PLoS One. 2012;7(8):e43841. doi: 10.1371/journal.pone.0043841. Epub 2012 Aug 29.
To assess whether people with learning disability in the UK have poorer access to cancer screening.
Four cohort studies comparing people with and without learning disability, within the recommended age ranges for cancer screening in the UK. We used Poisson regression to determine relative incidence rates of cancer screening.
The Health Improvement Network, a UK primary care database with over 450 General practices.
Individuals with a recorded diagnosis of learning disability including general diagnostic terms, specific syndromes, chromosomal abnormalities and autism in their General Practitioner computerised notes. For each type of cancer screening, a comparison cohort of up to six people without learning disability was selected for each person with a learning disability, using stratified sampling on age within GP practice.
Incidence rate ratios for receiving 1) a cervical smear test, 2) a mammogram, 3) a faecal occult blood test and 4) a prostate specific antigen test.
Relative rates of screening for all four cancers were significantly lower for people with learning disability. The adjusted incidence rate ratios (95% confidence intervals) were Cervical smears: Number eligible with learning disability = 6,254; IRR = 0.54 (0.52-0.56). Mammograms: Number eligible with learning disability = 2,956; IRR = 0.76 (0.72-0.81); Prostate Specific Antigen: Number eligible = 3,520; IRR = 0.87 (0.80-0.96) and Faecal Occult Blood Number eligible = 6,566; 0.86 (0.78-0.94). Differences in screening rates were less pronounced in more socially deprived areas. Disparities in cervical screening rates narrowed over time, but were 45% lower in 2008/9, those for breast cancer screening appeared to widen and were 35% lower in 2009.
Despite recent incentives, people with learning disability in the UK are significantly less likely to receive screening tests for cancer that those without learning disability. Other methods for reducing inequalities in access to cancer screening should be considered.
评估英国的学习障碍患者是否在癌症筛查方面的机会较差。
在英国癌症筛查推荐年龄范围内，对患有和不患有学习障碍的人群进行了四项队列研究。我们使用泊松回归来确定癌症筛查的相对发病率。
健康改善网络（Health Improvement Network）是一个英国初级保健数据库，拥有超过 450 家全科医生。
在全科医生的电脑记录中，有学习障碍记录诊断，包括一般诊断术语、特定综合征、染色体异常和自闭症。对于每一种癌症筛查，在每个学习障碍患者中，选择最多六个没有学习障碍的对照人群，按照 GP 实践中的年龄分层抽样。
接受 1）宫颈涂片检查、2）乳房 X 光检查、3）粪便潜血检查和 4）前列腺特异抗原检查的发生率比。
患有学习障碍的患者接受所有四种癌症筛查的相对比率明显较低。调整后的发病率比（95%置信区间）为：宫颈涂片：有学习障碍的合格人数=6254；IRR=0.54（0.52-0.56）。乳房 X 光检查：有学习障碍的合格人数=2956；IRR=0.76（0.72-0.81）；前列腺特异抗原：合格人数=3520；IRR=0.87（0.80-0.96）和粪便潜血合格人数=6566；0.86（0.78-0.94）。在社会较贫困地区，筛查率的差异不那么明显。宫颈筛查率的差距随着时间的推移逐渐缩小，但在 2008/9 年仍低 45%，乳腺癌筛查率似乎有所扩大，在 2009 年低 35%。
尽管最近有激励措施，但英国的学习障碍患者接受癌症筛查测试的可能性明显低于没有学习障碍的患者。应该考虑其他方法来减少癌症筛查机会的不平等。
